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Safety of Terbutaline for Treatment of Acute Severe Pediatric Asthma

Doymaz, Sule, MD; Schneider, James, MD

doi: 10.1097/PEC.0000000000000677
Original Articles

Objectives The use of continuous intravenous terbutaline treatment in severe asthma attacks has been hampered by the lack of well-powered clinical trials where effects of such treatment are described in detail. Here, we aimed to provide a descriptive report on the largest cohort of severe pediatric asthma patients treated with terbutaline.

Methods The study was conducted in a pediatric intensive care unit in a large metropolitan tertiary care university hospital on 124 patients receiving terbutaline infusion. To stratify the effect of, and determine any age-related differences of, terbutaline, the patients were divided into 3 age groups (0–6 years, 7–12 years, and 13–18 years). Clinical response and the potential harmful effects of terbutaline infusion were determined.

Results There were significant reductions in systolic (varying between 86% and 93% of the baseline) and diastolic blood pressures (varying between 74% and 86% of the baseline level). However, the values returned to baseline level shortly after discontinuation of infusion. Terbutaline increased heart rates in all groups shortly after initiation (9%–13% above baseline), which returned to below baseline levels 1 hour after discontinuation. Serum potassium levels were also reduced in all patients compared to their baseline values after initiation of terbutaline infusion. However, none of the subjects required potassium replacement.

Conclusions The results indicate that overall, terbutaline infusion was well tolerated without irreversible adverse effects of the treatment. Although hemodynamic and metabolic disturbances occurred, these were clinically easily managed and posed little risk in emergency department or pediatric intensive care unit.

From the Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of New York, New Hyde Park, NY.

The authors declare no conflict of interest.

Reprints: Sule Doymaz, MD, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (e-mail:

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